Health choice for old is to pay up or suffer
The most commonly cited quandary for elderly people used to be 'heat or eat' - as they were forced by high fuel costs to choose between staying warm or buying sufficient food for their needs.
Now they face another dilemma: whether to bear the pain of a debilitating illness or condition, or pay for private healthcare. The problem facing them - and it is a problem disproportionately affecting the elderly - is that waiting lists are of such numbers and such length that it could be up to two years before their first appointment.
With an ageing population, demand on NHS services are bound to increase, but the current size of the waiting lists and the time some people have to wait is scandalous, given that Northern Ireland is a relatively small place.
Recently this newspaper revealed that around one in five people is on some NHS waiting list or other, and now we can reveal that 33,600 people have been waiting more than a year for their first outpatient appointment. How much longer they would have to wait for any treatment is an unknown variable.
What it means is that their illness or condition will inevitably worsen, and in some cases illnesses may deteriorate so much that treatment may be ineffective.
For those who have any savings or a pension pot, the alternative is to seek private diagnosis and treatment. That is especially true for conditions like cataracts and joint replacements. Such procedures will not come cheaply and will certainly eat a large hole into most people's savings.
These are, in the main, people who have worked throughout their lives, paying their taxes and national insurance in the belief that the money would fund the NHS for when they needed it.
But when they do need treatment in older age, they find that it is not speedily available.
We know that the NHS consumes almost half of the entire budget given to Northern Ireland by the Treasury and that its spending power is ring-fenced. Obviously the ring needs to be bigger, or the NHS in Northern Ireland needs to be much more efficient.
The service is managed to within an inch of its life, with the department and trusts employing large numbers of people to oversee its running, yet successive ministers have failed to get it working efficiently. Perhaps they need fresh thinking and the courage to implement the required hard choices, which have been repeatedly spelled out.